Healthcare Provider Details

I. General information

NPI: 1073427662
Provider Name (Legal Business Name): RIVERSIDE PREPARATORY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19900 NATIONAL TRAILS HIGHWAY
ORO GRANDE CA
92368
US

IV. Provider business mailing address

19900 NATIONAL TRAILS HIGHWAY
ORO GRANDE CA
92368
US

V. Phone/Fax

Practice location:
  • Phone: 760-243-5884
  • Fax:
Mailing address:
  • Phone: 760-243-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: SCOTT HEITMAN
Title or Position: EXECUTIVE DIRECTOR, ED SERVICES
Credential:
Phone: 760-243-5884